a couple at the OBGYN discussing pregnancy and HIV

Pregnancy While Living with HIV

If you are living with HIV and planning a family or are already pregnant, you may have a lot of questions. The most important thing to know is this: most people living with HIV have healthy pregnancies and babies. Here are some things to know about staying healthy during pregnancy.

Can I have a baby if I am living with HIV?

Yes, you can! If you have a chance to plan your pregnancy, you can talk with your HIV and pregnancy care teams before you get pregnant. They can help you plan the best medicines to manage HIV and get your viral load (VL) as low as possible.

If you are already pregnant, talk with your doctors about managing HIV as soon as you can. This is the best way to keep you and your baby well.1

What if my partner lives with HIV, but I don’t?

If your partner has an undetectable viral load (VL), it is highly unlikely that they can transmit HIV to you during sex. The CDC says there is “effectively no risk”.2

If your partner is unable to suppress their viral load or does not know what their VL is, you can decrease your chance of getting the virus during sex by:3-6

  • Taking PrEP while you are trying to get pregnant
  • Using condoms except when you are ovulating, which is when you are most likely to get pregnant
  • Using artificial insemination, either with donor sperm or with your partner's prepared sperm

Will pregnancy make HIV worse?

If a person is taking antiretroviral therapy (ART), being pregnant does not make HIV worse. The viral load usually does not change much during pregnancy.7-9

Without treatment, HIV may get worse. This causes a higher chance of serious infections while pregnant. Starting treatment as soon as possible is generally the best way to stay healthy during pregnancy.1,7-9

Will my baby be healthy?

Babies can acquire HIV during pregnancy or birth, but it is uncommon in the United States. With no treatment, the chance of transmission from a parent who is HIV-positive to their baby can be around 1 in 4. But if the parent has a viral load of less than 1,000, the chance is less than 1 percent.10

If a person has been unable to get treatment during pregnancy, they can still take IV antiviral drugs just before delivery to protect the baby. Newborns can also take ART medications for the first few weeks of life to decrease the chance that they will get HIV.10,11

How will my pregnancy be different?

During pregnancy, keeping your viral load low is important for the health of both mother and baby. Your care team may check your blood tests more often than usual to watch those numbers closely.6

If your viral load is more than 1,000, your doctor may recommend a Cesarean birth to decrease the risk that your baby will get the virus during delivery. If your viral load is low or undetectable, a vaginal birth may be safer.10

Talk with your care team about the healthiest choice for your particular situation.

What about breastfeeding?

Whether to breastfeed your child or not is a very personal decision. There is a small risk of HIV transmission during breastfeeding. Even with an undetectable viral load, there may be a small amount of the virus in breastmilk.12

For this reason, in the United States, parents living with HIV are usually advised not to breastfeed. The actual risk is not certain, but for a parent taking ART with a low VL and for a baby taking PrEP, the risk may be less than 1 percent.12

Talk to your care team about the best decision for you and your family.

With ART, both parents living with HIV and their babies are likely to do well. If you are not yet on ART, starting treatment as soon as possible will help keep both you and your baby well.

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Dr. Audrey Sheridan is a board-certified obstetrician-gynecologist (OB-GYN) and also a caretaker for her dad. Dr. Sheridan is inspired by people finding their way through life-changing medical situations with resilience. She is interested in how we can increase our mental durability in the face of the unpredictable.

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